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• What is your primary diagnosis for Michelle given the pattern of occurrence of symptoms, exam results, and recent history?

Primary Diagnosis/History

Given the pattern of occurrence of Micheel’s symptoms, her primary diagnosis would most likely be occupational asthma (OA). Onset of symptoms begin when she is at work for only a few hours. Location, she is mainly only complaining of shortness of breath. Characteristics, she feels like she cannot catch her breath after arriving at work for a few hours. She also denies coughing up sputum, and denies heartburn..................... Continue

Exam Results/History

Upon physical examination, Michelle was noted to have her nares patent with thin white exudate, boggy/pale mucosa, deviated septum and non-tender sinuses. On auscultation, her lungs were clear bilaterally, had unlabored respirations, and slight wheezing heard upon inspiration and on force expiration. Her wheezing did not clear with a forced cough.................... Continue

• What is your first-line treatment plan for Michelle including medications, labs, education, referrals, and follow-up?

Medications

Drug Class: Short-Acting Bronchodilator Albuterol (SABA) Albuterol Sulfate Inhalation Aerosol (ProAir HFA) 90 mcg/actuation Sig: Take 1-2 inhalations every 4 hours by mouth as needed

Rationale: Short-acting beta agonist should only be used as needed for shortness of breath, wheezing, coughing, or chest tightness................... Continue

What will you tell her about the black box warning on Singular?

According to Singulair’s black box warning, it states that it has some serious neuropsychiatric side effects and we should let Michelle know about them. That way we can monitor her symptoms and we can either discontinue the medication or treat it.................... Continue

Should she continue the Zyrtec?

Yes she should continue Zyrtec because the mechanism of action of Zyrtec is different from Singulair. Her Zyrtec will help treat her seasonal allergies, while Singulair mainly targets the upper airways to reduce congestion, sneezing, itching, and watery eyes. ................... Continue

What will you tell her about the use of peak flow meters, spacers, asthma action plans, symptoms diaries?

Peak flow meters are used for patients and providers to quickly measure lung capacity which is important because it can measure if one’s airways are narrowed and blocked due to asthma. It is a small device that helps patients check how well their asthma is being controlled.................... Continue

Can you outline what you will do at her follow up visit? Remember you are her PCP office so consider primary secondary and tertiary prevention.

During her follow up visit we will review her Asthma Diary to identify her certain triggers. Identifying her triggers will help us formulate a plan to prevent them. Primary prevention is all about avoiding the substances that can trigger her asthma attacks, (GINA, 2022). It also includes educating Michelle on the importance of keeping up with her immunizations, especially her annual influenza vaccine.................... Continue